West Bengal: Out of control

As COVID cases soar in West Bengal, the State government admits that there has been community spread in several parts and experts stress the need for decentralised testing.

Fumigation under way in a containment zone in south Kolkata.

With the COVID-19 situation threatening to spiral out of control in West Bengal, the Trinamool Congress government faces an uphill task. While Chief Minister Mamata Banerjee continues to fall back on her rhetoric of Bengal’s COVID management being among the best in the country and blame the Centre for its lack of cooperation, the State government has admitted that community spread has begun in certain areas. It has also announced complete lockdown across the State for two days every week. The government will announce in advance which two days those will be, perhaps on a weekly basis. As the numbers increase, repeated incidents of medical negligence and helplessness of the common people in the face of the pandemic have brought to the fore glaring lapses in the State’s health-care system. The State government finds itself in a situation where it must contend with not only political agitations but also increasing public dissatisfaction.

The State witnessed an uncontrollable acceleration in the contagion from the beginning of July. In the first three weeks of the month, the caseload increased by more than 26,000 and the number of deaths by almost 500. On June 30, the total number of cases was 18,559 and the number of deaths 683. By July 20, the total number of cases had increased to 44,769 (including 2,282 new cases in 24 hours), of which 17,916 were active, and the total number of deaths stood at 1,182 (including 35 on July 20).

West Bengal’s relatively high rate of discharge was a point of pride with the State government for quite some time. With positive cases increasing rapidly, however, it dipped drastically, from 65.35 per cent on July 1 to 59 per cent by July 20. The daily rate of testing, which had begun to pick up in June (it crossed the 10,000-mark on June 19), remained stagnant for nearly four weeks, hovering between 10,300 and 11,500. Only from July 16 was there a perceptible increase in testing, with more than 13,000 tests taking place every day. As of July 20, the State had tested 7,16,365 samples (including 13,081 on July 20), with the rate of testing per million standing at a mere 7,960.

On July 20, the State government announced for the first time that community transmission had started. Home Secretary Alapan Bandopadhyay told the media: “After consulting with several scientists, experts and those related with the matter, we feel that community transmission has been taking place in certain areas.” He also announced the move to impose lockdown for two days a week. Lockdowns in various “containment zones” are already in place. Earlier, the State had embargoed flights coming in from Delhi, Mumbai, Chennai, Ahmedabad, Nagpur and Pune until July 19; the ban has been extended to July 31.

Decentralised testing

Some virologists and medical practitioners are sceptical about the State government’s measures. Partho Sarothi Ray, eminent virologist and molecular scientist and Associate Professor at the Indian institute of Science Education and Research, Kolkata, told Frontline : “People were given the impression that the lockdown would make the epidemic go away, but that can never happen. What we are seeing is that during the lockdown, the infection got incubated. People stayed indoors and the infection spread among those in close contact, and now with the unlocking, it has started spreading everywhere, and it will continue to spread in an accelerated way… The only way to deal with the situation is what was being advocated all through—to test, trace and isolate.” He felt that the Central and State governments seemed to be dealing with the situation as though it were a law and order problem. He said it was a public health and scientific problem that should be dealt with scientifically and epidemiologically. According to Ray, both the Centre and the State government had been just “fighting with a shadow” and the present situation was a result of the lack of planning by the government.

Ray said “decentralised” testing was essential right now and pointed out that testing capacity in the State had been enhanced in a “delayed and half-hearted manner”. “I am involved with the testing in Nadia district. Here we are planning and focussing on areas from where infections are coming, and how testing can be geared up to isolate people fast as soon as there is an infection arising in an area. But in almost every State all the samples are going to a few laboratories in the capital and everything is getting mixed up. As a result, there is no understanding of the dynamics of how the infection is spreading locally. By the time the results come in, clusters of infection spread. Testing locally should have been established much earlier,” he said. He believes that antigen testing should begin immediately in the cities.

Government under fire

Notwithstanding Mamata Banerjee’s claim that “Bengal is the best” in health and hospital infrastructure, repeated incidents of patients struggling with lack of infrastructure and of deaths caused by alleged negligence have given opposition parties a handle to attack the State government with. The recent death of 18-year-old Subhrajit Chatterjee, who was allegedly refused treatment in several hospitals—including a government hospital—sent shockwaves across the State. A private hospital allegedly proclaimed Subhrajit, who was having breathing difficulties, COVID-positive on a hand-written note and asked his parents to take him to a government hospital. After more than 12 hours of suffering and shuttling from one place to another, the boy was finally admitted to Medical College and Hospital, Kolkata, but only after his mother threatened to commit suicide on the premises. That very night the boy passed away. His father, Biswajit Chatterjee, was quoted in the media as having said: “The medical college too had refused us initially, saying there weren’t beds available. Then when my wife threatened to commit suicide, they took him in. We shifted him to the isolation ward and saw there were three empty beds.”

The boy’s parents claimed they had appealed to the police and the administration for help in their moment of anguish, but to no avail. The Calcutta High Court ordered a post-mortem after they moved court. “I still do not know what killed my son, the COVID virus or medical negligence,” said Shrabani, the boy’s mother. Though Subhrajit’s case was not an isolated one and complaints by patients were almost a daily occurrence, it sparked off strong reactions in social and political circles.

Mamata Banerjee responded with boasts about the State’s infrastructure in the health sector. “We have invested so much money in the health sector and created so much new infrastructure that I can proudly claim that Bengal’s health system is the best and that can be gauged by the occupancy rate in the government hospitals,” she said. Yet, on July 20, out of the 11,239 COVID beds in government establishments, 7,071 were unoccupied, whereas, according to a highly placed source in the private medical sector, the occupancy rate in private COVID hospitals was around 97 per cent. According to the State government’s own figures, the overall occupancy of COVID beds in the State was a mere 37.09 per cent as of July 20. Addressing the media on July 16, Mamata Banerjee said steps were being taken to add another 3,500 to 4,000 COVID beds. A doctor explained to Frontline : “The unfortunate fact is that even those who cannot afford treatment in a private hospital would rather not go to a government one. We also see many people not coming forward to get their tests done, hoping to recover at home.”

Under pressure from all quarters, Mamata Banerjee appealed to the media to “show the positive news”. Chief Secretary Rajiva Sinha assured the people that there was no reason for panic: “Look at both the macro and micro pictures instead of just the numbers. As of today [July 18], out of 14,709 active cases in Bengal, only 662 patients are in the serious category, while 1,250 are in the moderate category. That means only 1,912 patients need to be in hospital. The remaining 12,796 are asymptomatic…Is it a big number?” However, according to an eminent doctor, in the present situation “it would be pernicious for the government to be complacent as it would give the public a false sense of security.”